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증례 : 소화기 ; 식도의 점막하 종양으로 오인된 종격동 결핵성 림프절염
김세진 ( Se Jin Kim ),정석원 ( Seok Won Jung ),황세진 ( Se Jin Hwang ),이영암 ( Young Arm Yi ),김종민 ( Jong Min Kim ),성시정 ( Shi Jung Sung ),정인두 ( In Du Jeong ) 대한내과학회 2011 대한내과학회지 Vol.80 No.3
식도 결핵이 드문 질환이기는 하지만 우리나라가 결핵 유병률이 높은 지역임을 감안하면 식도에 달리 설명하기 어려운 궤양성 병변이나 종괴형 병변이 관찰될 때, 특히 식도 점 막하 종양의 형태로 나타날 경우, 식도 결핵을 감별 진단의 하나로 고려해야 한다. 식도 결핵이 의심되면 상부 위장관 내시경검사에 의한 조직 생검 또는 수술 후 병리소견에 의해 최종적으로 진단될 수 있으나, 여러 차례의 내시경 조직검사에서 비특이성 만성 염증만 나타나는 경우가 많다. 조직검사에서 만족할 만한 소견이 나오지 않은 경우, 항산성균을 발견하거나 결핵 중합효소 연쇄반응을 시행하여 식도 결핵을 반드시 감별하여야 한다. Esophageal involvement in tuberculosis is rare, and the clinical presentation may mimic an esophageal submucosal tumor. A 30-year-old woman presented with dysphagia for 1 month. At esophagoscopy, a 3-cm subepithelial mass with normal covering mucosa was found 28~25 cm from the upper incisors. We diagnosed the lesion as a submucosal tumor of the esophagus and performed endoscopic ultrasonography 1 week after the first examination. The second endoscopy showed a large, linear ulceration on the same subepithelial mass. The histologic examination obtained following an endoscopic biopsy revealed chronic granulomatous inflammation, and a molecular nested PCR study for Mycobacterium tuberculosis was positive. The final diagnosis was mediastinal tuberculous lymphadenitis with invasion into the esophagus. We suggest the use of molecular biology techniques when there is a strong clinical suspicion of tuberculosis and difficulty in arriving at a definite diagnosis. (Korean J Med 2011;80:328-332)
기관지확장증 환자의 객담 균주 분석: 울산지역의 일개 대학병원 보고
서광원 ( Kwang Won Seo ),황세진 ( Se Jin Hwang ),성시정 ( Shi Jung Sung ),김세진 ( Se Jin Kim ),도기원 ( Gi Won Do ),허성재 ( Seong Jae Hur ),임경훈 ( Kyung Hun Lim ),홍순형 ( Soon Hyung Hong ),김동민 ( Dong Min Kim ),전재범 ( Jae 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.6
Background: Bronchiectasis (BE) remains a rare respiratory disease in Korea. This retrospective study was done to investigate the potential pathogenic microorganisms (PPMs) that cause in patients with BE, through the use of sputum specimens. Methods: One hundred eleven adult patients, who had undergone chest computed tomography (CT), sputum gram stain/culture, and BE detected by chest CT, were included in this study. Sputum adequacy was determined by using Murray-Washington classification. Results: The mean (±SD) age of patients was 60.9 (±14.0). The number of PPMs was 167 (67%) in the total 248 isolated organisms. The most frequent PPMs were P. aeruginosa (23.4%), K. pneumoniae (10.5%), and S. aureus (8.4%). The proportion of adequate sputum (AS) was 25.8% in the total sputum specimens. The patients with AS were 41 (37%) and the patients with inadequate sputum (IS) were 70 (63%). The proportion of P. aeruginosa was higher in AS compared to that of IS (44% vs. 19%, p=0.004). The BE score was also higher in P. aeruginosa (+) patients compared to that of P. aeruginosa (-) patients (10.8vs.7.6, p=0.001). Conclusion: Although the proportion of AS in the total sputum was low, PPMs were isolated in most patients with BE. It is likely that P. aeruginosa was isolated in AS and AS patients had higher BE scores.